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1.
Background
The National Lung Screening Trial showed a reduction in overall and cancer-specific mortality for patients screened with low-dose computed tomography (LDCT) versus chest radiograph. Some question whether this can be achieved in community healthcare settings. Our aim was to analyze lung cancer screening outcomes and administered radiation dose using LDCT scans at a community hospital.Patients and Methods
We retrospectively reviewed the records of 680 patients who underwent LDCT between June 2014 and December 2015, and who met Centers for Medicare and Medicaid Services lung cancer screening criteria: asymptomatic, aged 55 to 77 years, smoked within the last 15 years, and ≥ 30 pack-year history. Effective and absorbed doses were calculated and correlated with gender and body mass index.Results
Among the 133 patients (19.6%) with a positive screening result (Lung Imaging Reporting and Data System score of 3 or 4), 18 lung cancers were identified in 16 patients, 56.3% (9 of 16) of which were stage I non–small-cell lung cancer. The false-positive rate was 82.8% (95% confidence interval, 73.6%-89.8%). Mean estimated effective dose using dose length product and size-specific dose estimate using water equivalent diameter were 1.2 mSv and 3.7 mGy for women and 1.4 mSv and 3.9 mGy for men, respectively. All dosing metrics were strongly correlated with body mass index (P < .0001).Conclusions
Over half of screening patients diagnosed with non–small-cell lung cancer in our community had stage I disease, which we anticipate translating into significantly improved mortality. Patient radiation dose from LDCT scans is approximately one-fifth that from standard CT chest examinations. 相似文献2.
Apar Kishor Ganti Fred R. Hirsch Murry W. Wynes Arliene Ravelo Suresh S. Ramalingam Raluca Ionescu-Ittu Irina Pivneva Hossein Borghaei 《Clinical lung cancer》2017,18(6):640-650.e2
Background
Access to specialty care is critical for patients with advanced stage lung cancer. This study assessed access to cancer specialists and cancer treatment in a broad population of patients with advanced stage lung cancer.Materials and Methods
Two study samples were extracted from 2 claims databases and analyzed independently: patients aged ≥ 18 years with de novo diagnosis of metastatic lung cancer in the MarketScan database between 2008 and 2014 (commercially insured adult patients; n = 22,268); and patients aged ≥ 65 years in the Surveillance, Epidemiology, and End Results–Medicare database with a diagnosis of advanced non–small-cell lung cancer between 2007 and 2011 (Medicare-insured elderly patients; n = 9651). The study period spanned from 6 weeks before the first lung biopsy tied to the initial lung cancer diagnosis until the end of continuous health insurance enrollment, or data availability, or death.Results
Among the commercially insured adults (MarketScan), most patients were seen by a cancer specialist within a month of first lung biopsy (80%), 12% were never seen by a cancer specialist, and 6% did not receive cancer-directed therapy. Among the Medicare-insured elderly patients (SEER–Medicare), the proportions were 79%, 4%, and 10%, respectively. Patients seen by a cancer specialist were more likely to receive cancer-directed therapy (95% vs. 92%, P < .001 and 92% vs. 38%, P < .001, respectively).Conclusion
Between 4% and 12% of patients with advanced stage lung cancer do not have appropriate access to cancer specialist, which appears to negatively affect access to optimal and timely treatment. 相似文献3.
Karlijn J.G. Schulkes Esteban T.D. Souwer Leontine J.R. van Elden Henk Codrington Simone van der Sar-van der Brugge Jan-Willem J. Lammers Johanneke E.A. Portielje Frederiek van den Bos Marije E. Hamaker 《Clinical lung cancer》2017,18(6):660-666.e1
Background
Because of the time-consuming aspect of geriatric assessments, cancer specialists are seeking shorter screening tools to distinguish fit and frail patients. We analyzed the predictive value of the Geriatric 8 (G8) and Identification of Seniors at Risk for Hospitalized Patients (ISAR-HP) in elderly patients with lung cancer.Patients and Methods
From January 2014 to April 2016, the data from patients with lung cancer aged > 70 years at 2 teaching hospitals in the Netherlands were included in a database. The patients were classified as potentially frail if they had a G8 of ≤ 14 or ISAR-HP of ≥ 2.Results
Of the 142 included patients (median age, 77 years; interquartile range, 73-82 years), 108 (76%) were potentially frail. After correction for possible confounders, the potentially frail patients had a significantly greater risk of 1-year mortality (hazard ratio [HR], 4.08; 95% confidence interval [CI] 1.67-9.99; P = .02). Higher disease stage (HR, 1.72; 95% CI, 1.40-2.12; P < .001) was also a significant predictor of mortality; however, initial treatment (standard or otherwise) and age were not. When using both screening instruments separately, an impaired score on the G8 and higher disease stage were the variables remaining in the regression analyses (HR for impaired G8, 3.01; 95% CI, 1.35-6.72; P < .001). Patients with impaired scores on the ISAR-HP and G8 had more geriatric impairments than did patients with only an impaired G8 score.Conclusion
G8 screening is useful for the prognostication of elderly patients with lung cancer and could be used in combination with ISAR-HP to increase specificity at the cost of sensitivity. Using the ISAR-HP as the only screening tool would be insufficient. 相似文献4.
Dan J. Raz Geena X. Wu Martin Consunji Rebecca A. Nelson Heeyoung Kim Can-lan Sun Virginia Sun Jae Y. Kim 《Clinical lung cancer》2018,19(1):51-57
Introduction
Lung cancer screening (LCS) with low-dose computed tomography (LDCT) is recommended by the U.S. Preventive Services Task Force (USPSTF) in high-risk patients, but a minority of eligible people are screened. It is not clear whether knowledge of USPSTF recommendations among primary care physicians (PCP) affects utilization of LDCT.Methods
A randomly selected sample of 1384 PCPs in Los Angeles County was surveyed between January and October 2015, using surveys sent by mail, fax, and e-mail. The response rate was 18% (n = 250). Training background, years in practice, practice type, and respondent demographics were collected. We analyzed results based on the response to a question on whether the USPSTF recommends the use of LDCT to screen high-risk individuals for lung cancer.Results
A total of 117 (47%) PCPs responded that the USPSTF recommends LDCT for LCS. Of PCPs who were aware of USPSTF recommendations, 97% responded that CT was effective at reducing lung cancer mortality among individuals meeting eligibility criteria, compared with 90% who were unaware of guidelines (P = .02). A larger proportion of PCPs aware of guidelines ordered LDCT (71% vs. 38%, P < .001) and initiated a discussion on screening (86% vs. 62%, P < .001). Both groups of PCPs reported similar perceptions of barriers to screening, such as insurance coverage, risks of LCS, and cost to society. Practice size, training background, and years in practice did not affect knowledge of guidelines.Discussion
Awareness of USPSTF recommendations for LDCT is associated with increased utilization of LDCT for screening. Educational interventions for PCPs may improve adherence with LCS recommendations. 相似文献5.
Satoshi Hamauchi Kentaro Yamazaki Toshiki Masuishi Yosuke Kito Azusa Komori Takahiro Tsushima Yukiya Narita Akiko Todaka Makoto Ishihara Tomoya Yokota Tsutomu Tanaka Nozomu Machida Shigenori Kadowaki Akira Fukutomi Takashi Ura Yusuke Onozawa Masashi Ando Masahiro Tajika Hiroya Taniguchi 《Clinical colorectal cancer》2017,16(1):51-57
Background
TAS-102 significantly improves overall survival in patients with metastatic colorectal cancer. The most common treatment-related adverse event of TAS-102 is bone marrow suppression, which leads to neutropenia. The potential predictive value of neutropenia caused by cytotoxic drugs has been reported in various types of cancer.Methods
We retrospectively analyzed 95 consecutive patients with metastatic colorectal cancer who received TAS-102 at 2 Japanese institutions between May 2014 and May 2015. To evaluate the association between efficacy and neutropenia, patients were divided into 4 categories according to the grade of neutropenia during the first cycle of TAS-102: Category A (grade 0-1), B (grade 2-4), C (grade 0-2), and D (grade 3-4).Results
Patient characteristics were as follows: median age, 64 years; male, 58%; Eastern Cooperative Oncology Group performance status 0 to 1, 91%; primary site colon, 49%; KRAS exon 2 wild, 57%; and number of metastatic site ≥ 3, 55%. The disease control rate was significantly different between Category A and B (29.2% vs. 52.6%; P = .045) and between Category C and D (30.9% vs. 72.2%; P = .002). In multivariate analysis, Category D remained a significant predictive factor for progression-free survival compared with Category C (4.3 vs. 2.0 months; hazard ratio, 0.45; P = .01).Conclusion
Neutropenia caused by TAS-102 during the first cycle was associated with better efficacy. Neutropenia may be a surrogate marker for adequate antitumor doses of TAS-102. 相似文献6.
Alona Zer Mor Moskovitz David M. Hwang Anat Hershko-Klement Ludmila Fridel Grzegorz J. Korpanty Elizabeth Dudnik Nir Peled Tzippy Shochat Natasha B. Leighl Geoffrey Liu Ronald Feld Ronald Burkes Mira Wollner Ming-Sound Tsao Frances A. Shepherd 《Clinical lung cancer》2017,18(2):156-161
Background
Patients with lung cancer are at increased risk for venous thromboembolism (VTE), particularly those receiving chemotherapy. It is estimated that 8% to 15% of patients with advanced non–small-cell lung cancer (NSCLC) experience a VTE in the course of their disease. The incidence in patients with specific molecular subtypes of NSCLC is unknown. We undertook this review to determine the incidence of VTE in patients with ALK (anaplastic lymphoma kinase)-rearranged NSCLC.Patients and Methods
We identified all patients with ALK-rearranged NSCLC diagnosed and/or treated at the Princess Margaret Cancer Centre (PM CC) in Canada between July 2012 and January 2015. Retrospective data were extracted from electronic medical records. We then included a validation cohort comprising all consecutive patients with ALK-rearranged NSCLC treated in 2 tertiary centers in Israel.Results
Within the PM CC cohort, of 55 patients with ALK-rearranged NSCLC, at a median follow-up of 22 months, 23 (42%) experienced VTE. Patients with VTE were more likely to be white (P = .006). The occurrence of VTE was associated with a trend toward worse prognosis (overall survival hazard ratio = 2.88, P = .059). Within the validation cohort (n = 43), the VTE rate was 28% at a median follow-up of 13 months. Combining the cohorts (n = 98), the VTE rate was 36%. Patients with VTE were younger (age 52 vs. 58 years, P = .04) and had a worse Eastern Cooperative Oncology Group performance status (P = .04). VTE was associated with shorter overall survival (hazard ratio = 5.71, P = .01).Conclusion
The rate of VTE in our ALK-rearranged cohort was 3- to 5-fold higher than previously reported for the general NSCLC population. This warrants confirmation in larger cohorts. 相似文献7.
Stephen J. Bagley Steven Vitale Suhong Zhang Charu Aggarwal Tracey L. Evans Evan W. Alley Roger B. Cohen Corey J. Langer Ian A. Blair Anil Vachani Alexander S. Whitehead 《Clinical lung cancer》2017,18(2):e143-e149
Introduction
Pemetrexed inhibits folate-dependent enzymes involved in pyrimidine and purine synthesis. Previous studies of genetic variation in these enzymes as predictors of pemetrexed efficacy have yielded inconsistent results. We investigated whether red blood cell (RBC) total folate, a phenotypic rather than genotypic, marker of cellular folate status was associated with the response to pemetrexed-based chemotherapy in advanced nonsquamous non–small-cell lung cancer (NSCLC).Materials and Methods
We conducted a prospective cohort study of patients with stage IV nonsquamous NSCLC receiving first-line chemotherapy containing pemetrexed. The pretreatment RBC total folate level was quantified using liquid chromatography mass spectrometry. We then compared the objective response rate (ORR) between patients with RBC total folate concentrations greater than and less than an optimal cutoff value determined from the receiver operating characteristic curve. A logistic regression model was used to adjust for age, sex, and the use of bevacizumab.Results
The ORR was 62% (32 of 52 patients). Receiver operating characteristic analysis was used to establish that a RBC total folate cutoff value of 364.6 nM optimally discriminated between pemetrexed responders and nonresponders. Patients with RBC total folate < 364.5 nM had an ORR of 27% compared with 71% for patients with RBC total folate > 364.5 nM (P = .01). This difference persisted after adjusting for age, sex, and the use of bevacizumab (odds ratio, 0.07; 95% confidence interval, 0.01-0.57; P = .01).Conclusion
A low pretreatment RBC total folate was associated with an inferior response to pemetrexed-based chemotherapy in stage IV nonsquamous NSCLC. Larger, multicenter studies are needed to validate RBC total folate as a predictive marker of pemetrexed response. 相似文献8.
Vivek Verma Charles B. Simone Pamela K. Allen Steven H. Lin 《Clinical lung cancer》2017,18(6):675-681.e1
Background
Although T1-T2N0 non–small cell lung cancer can be managed with stereotactic body radiotherapy (SBRT) alone, this management has often been extrapolated to T1-T2N0 small cell lung cancer (SCLC). This secondary analysis of a multi-institutional cohort study investigated whether the addition of chemotherapy and prophylactic cranial irradiation (PCI) improved the outcomes for these patients.Materials and Methods
All cases of histologically confirmed T1-T2N0M0 SCLC were obtained from 24 institutions' prospectively collected SBRT databases. The clinical and treatment characteristics, toxicities, outcomes, and patterns of failure were assessed. We used Kaplan-Meier analysis to evaluate the survival outcomes. Univariate and multivariate analyses identified the predictors of outcomes.Results
From 24 institutions, 76 lesions were treated in 74 patients (median follow-up, 18 months). Chemotherapy and PCI were delivered in 56% and 23% of cases, respectively. The median SBRT dose per fraction was 50 Gy/5 fractions. Patients receiving chemotherapy experienced increased median disease-free survival (61.3 vs. 9.0 months; P = .02) and overall survival (31.4 vs. 14.3 months; P = .02). Chemotherapy independently predicted for better outcomes for disease-free survival and overall survival on multivariate analysis (P = .01). Toxicities were uncommon; 5.2% experienced grade ≥ 2 pneumonitis. Post-treatment failures were most commonly distant (45.8% of recurrences), followed by nodal (25.0%), and elsewhere in the lung (20.8%). The median time to each was 5 to 7 months.Conclusion
Patients undergoing primary SBRT for T1-T2N0 SCLC should also undergo additional chemotherapy. No established role was found for PCI in this population. 相似文献9.
Introduction
We examined the value of tumor location in predicting the clinicopathologic features, survival, and metastases of pulmonary adenocarcinoma.Patients and Methods
A total of 417 cases of pulmonary adenocarcinoma were included in the present study. The tumors with invasion of the segmental and/or lobar bronchus were classified as central adenocarcinoma and those without as peripheral adenocarcinoma. Histologic grade, cytologic features, and adenocarcinoma type (terminal respiratory unit [TRU] type vs. non-TRU type) were compared between the 2 groups. The prognostic factors for disease-free survival (DFS) were analyzed using univariate and multivariate analyses.Results
Central adenocarcinoma was associated with lymphatic and/or vascular invasion (P = .011), necrosis (P < .001), high histologic grade (P = .004), and advanced stage (P < .001). For lung adenocarcinoma 1 to 4 cm in size, central adenocarcinoma was linked to a greater rate of nodal metastasis than peripheral adenocarcinoma. However, for lung adenocarcinoma of other sizes, central and peripheral adenocarcinoma had no differences in the rates of nodal metastasis. For nuclear features, central adenocarcinoma showed high mitotic counts, advanced nuclear atypia, and larger nuclei (P < .001, P < .001, P < .001, respectively). More peripheral adenocarcinomas than central adenocarcinomas were TRU type (229 of 281 [81.5%] vs. 58 of 136 [42.6%]; P < .001). Multivariate survival analyses of DFS showed that tumor location (central vs. peripheral, hazard ratio, 1.744; P < .001) was a stage-independent prognostic factor.Conclusion
Central adenocarcinoma is associated with a high potential for regional lymph node metastases, even at a small size. The results of our study showed that tumor location is an important factor for choosing treatment strategies and predicting DFS. 相似文献10.
Richard J. Cassidy Pretesh R. Patel Xinyan Zhang Robert H. Press Jeffrey M. Switchenko Rathi N. Pillai Taofeek K. Owonikoko Suresh S. Ramalingam Felix G. Fernandez Seth D. Force Walter J. Curran Kristin A. Higgins 《Clinical lung cancer》2017,18(5):551-558.e6
Background
Stereotactic body radiotherapy (SBRT) is the standard of care for medically inoperable early-stage non–small-cell lung cancer. Despite the limited number of octogenarians and nonagenarians on trials of SBRT, its use is increasingly being offered in these patients, given the aging cancer population, medical fragility, or patient preference. Our purpose was to investigate the efficacy, safety, and survival of patients ≥ 80 years old treated with definitive lung SBRT.Methods
Patients who underwent SBRT were reviewed from 2009 to 2015 at 4 academic centers. Patients diagnosed at ≥ 80 years old were included. Kaplan-Meier and multivariate logistic regression and Cox proportional hazard regression analyses were performed. Recursive partitioning analysis was done to determine a subgroup of patients most likely to benefit from therapy.Results
A total of 58 patients were included, with a median age of 84.9 years (range, 80.1-95.2 years), a median follow-up time of 19.9 months (range, 6.9-64.9 months), a median fraction size of 10.0 Gy (range, 7.0-20.0 Gy), and a median number of fractions of 5.0 (range, 3.0-8.0 fractions). On multivariate analysis, higher Karnofsky performance status (KPS) was associated with higher local recurrence-free survival (hazard ratio [HR], 0.92; P < .01), regional recurrence-free survival (HR, 0.94; P < .01), and overall survival (HR, 0.91; P < .01). On recursive partitioning analysis, patients with KPS ≥ 75 had improved 3-year cancer-specific and overall survival (99.4% and 91.9%, respectively) compared with patients with KPS < 75 (47.8% and 23.6%, respectively; P < .01).Conclusion
Definitive lung SBRT for early-stage non–small-cell lung cancer was efficacious and safe in patients ≥ 80 years old. Patients with a KPS of ≥ 75 derived the most benefit from therapy. 相似文献11.
Mihong Choi Youngjoo Lee Sung Ho Moon Ji-Youn Han Heung Tae Kim Jin Soo Lee 《Clinical lung cancer》2017,18(1):77-84
Background
Prophylactic cranial irradiation (PCI) was reported to offer survival benefits in patients with limited stage small-cell lung cancer (LS-SCLC). However, earlier studies did not routinely use positron emission tomography (PET) as part of the initial evaluation, thereby reducing the accuracy of tumor staging. We examined the effect of more accurate staging with PET on the role of PCI in patients with LS-SCLC.Patients and Methods
We retrospectively collected data from 280 patients with LS-SCLC who had objective responses after combined chemoradiotherapy between 2001 and 2013. The outcomes of PCI were analyzed after stratifying the patients according to whether or not the initial staging included PET imaging.Results
The risk of brain metastasis as the first site of relapse was lower in patients who received PCI than in those who did not, only in patients without initial PET imaging (13.3% vs. 37.0%; P = .020), but not in patients with initial PET imaging (34.3% vs. 41.1%; P = .243). There was no survival difference between subgroups who received PCI or not (5-year survival rates, 34.8% vs. 34.1%; P = .938). Patients who had initial staging evaluation with PET achieved long-term survival even without PCI (5-year survival rates, 38.3% with PCI, 38.6% without PCI).Conclusion
The role of PCI needs to be critically reassessed in LS-SCLC patients whose initial staging evaluation included PET because the benefit of PCI was not apparent for them. 相似文献12.
Gouji Toyokawa Kazuki Takada Tatsuro Okamoto Yuka Kozuma Taichi Matsubara Naoki Haratake Shinkichi Takamori Takaki Akamine Masakazu Katsura Fumihiro Shoji Yoshinao Oda Yoshihiko Maehara 《Clinical lung cancer》2017,18(5):504-511.e1
Objective
Emphysematous bullae (EB) are known to be associated with a high incidence of lung cancer; however, the reason for this has yet to be elucidated. The objective of the present study was to clarify the prevalence of programmed death-ligand-1 (PD-L1) expression in EB-associated lung adenocarcinomas.Patients and Methods
A total of 369 patients with resected lung adenocarcinoma whose preoperative computed tomography findings were available for the examination of EB were analyzed for PD-L1 expression by immunohistochemistry and evaluated to determine the association between PD-L1 expression and EB-related adenocarcinomas.Results
Among 369 patients, EB and cancer adjoining EB (Ca-ADJ) were identified in 81 (22.0%) and 50 (13.6%) patients, respectively. EB and Ca-ADJ were significantly associated with male gender, a smoking habit, a decreased forced expiratory volume in 1 second, a relatively higher tumor grade, advanced T status and stage, the presence of pleural and vessel invasion, invasive pathologic subtypes, and wild-type epidermal growth factor receptor. Seventy patients (19.0%) were positive for PD-L1 expression, whereas the remaining 299 patients (81.0%) were negative. Thirty-six (44.4%) and 29 (58.0%) of 81 and 50 patients with EB and Ca-ADJ, respectively, were positive for PD-L1 expression, which was shown to be significant by the Fisher exact test (P < .001 and P < .001, respectively). Among the 81 lung adenocarcinomas with EB, Ca-ADJ was significantly associated with PD-L1 expression (P = .021). In a multivariate analysis, the presence of Ca-ADJ was found to be an independent predictor of PD-L1 expression.Conclusions
EB-associated lung adenocarcinomas express PD-L1 protein more frequently than those without EB. 相似文献13.
Natasha B. Leighl Naiyer A. Rizvi Lopes Gilberto de Lima Wichit Arpornwirat Charles M. Rudin Alberto A. Chiappori Myung-Ju Ahn Laura Q.M. Chow Lyudmila Bazhenova Arunee Dechaphunkul Patrapim Sunpaweravong Keith Eaton Jihong Chen Sonja Medley Srinivasu Poondru Margaret Singh Joyce Steinberg Rosalyn A. Juergens Shirish M. Gadgeel 《Clinical lung cancer》2017,18(1):34-42.e2
Introduction
First-line epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor treatment of advanced non–small-cell lung cancer with EGFR-activating mutations improves outcomes compared with chemotherapy, but resistance develops in most patients. Compensatory signaling through type 1 insulin-like growth factor 1 receptor (IGF-1R) may contribute to resistance; dual blockade of IGF-1R and EGFR may improve outcomes.Patients and Methods
We performed a randomized, double-blind, placebo-controlled phase II study of linsitinib, a dual IGF-1R and insulin receptor tyrosine kinase inhibitor, plus erlotinib versus placebo plus erlotinib in chemotherapy-naive patients with EGFR-mutation positive, advanced non–small-cell lung cancer. Patients received linsitinib 150 mg twice daily or placebo plus erlotinib 150 mg once daily on continuous 21-day cycles. The primary end point was progression-free survival.Results
After randomization of 88 patients (44 each arm), the trial was unblinded early owing to inferiority in the linsitinib arm. The median progression-free survival for the linsitinib versus the placebo group was 8.4 months versus 12.4 months (hazard ratio, 1.37; P = .29). Overall response rate (47.7% vs. 75.0%; P = .02) and disease control rate (77.3% vs. 95.5%; P = .03) were also inferior. Whereas most adverse events were ≤ grade 2, linsitinib plus erlotinib was associated with increased adverse events that led to decreased erlotinib exposure (median days, 228 vs. 305). No drug-drug interaction was suggested by pharmacokinetic and pharmacodynamic results.Conclusion
Adding linsitinib to erlotinib resulted in inferior outcomes compared with erlotinib alone. Further understanding of the signaling pathways and a biomarker that can predict efficacy is needed prior to further clinical development of IGF-1R inhibitors in lung cancer. 相似文献14.
Gouji Toyokawa Kazuki Takada Tatsuro Okamoto Mototsugu Shimokawa Yuka Kozuma Taichi Matsubara Naoki Haratake Shinkichi Takamori Takaki Akamine Masakazu Katsura Fumihiro Shoji Yoshinao Oda Yoshihiko Maehara 《Clinical lung cancer》2017,18(6):e375-e383
Introduction
The development of immune checkpoint inhibitors against programmed death 1 has paved the way for a new era of treatment of lung cancer. Programmed death-ligand 1 (PD-L1) is expected to predict the response of immune checkpoint inhibitors in lung cancer. Predicting PD-L1 expression using a noninvasive method before immunotherapy would, therefore, help identify patients for whom immunotherapy can be successful.Patients and Methods
A total of 394 patients with resected lung adenocarcinoma who had undergone preoperative thin-section computed tomography (CT) were analyzed for PD-L1 expression by immunohistochemistry and evaluated to determine the association between PD-L1 expression and CT characteristics, including convergence, surrounding ground glass opacity (GGO), air bronchogram, notching, pleural indentation, spiculation, and cavitation.Results
Of the 394 patients, 78 (19.8%) were positive and 316 (80.2%) were negative for PD-L1 expression. Univariate analysis demonstrated that PD-L1+ adenocarcinoma was significantly associated with the presence of convergence (P < .01), notching (P < .01), spiculation (P < .01), and cavitation (P < .01) and the absence of surrounding GGO (P < .01) compared with PD-L1? cases. On multivariate analysis, the presence of convergence (P < .01) and cavitation (P < .01) and the absence of surrounding GGO (P = .02) and air bronchogram (P = .03) were significantly associated with PD-L1 expression.Conclusion
PD-L1+ adenocarcinoma cases showed convergence and cavitation more frequently than did PD-L1? cases. In contrast, surrounding GGO and air bronchogram were observed less frequently in PD-L1+ cases than in PD-L1? cases. These results will prove helpful in identifying PD-L1–expressing adenocarcinoma by CT before immunotherapy. 相似文献15.
P. Zhang C.-Z. Li C.-T. Wu G.-M. Jiao F. Yan H.-C. Zhu X.-P. Zhang 《European journal of surgical oncology》2017,43(2):285-293
Background
The purpose of this study was to compare patient outcomes between immediate breast reconstruction (IBR) after mastectomy and mastectomy alone.Methods
We conducted a comprehensive literature search of PUBMED, EMBASE, Web of Science, and Cochrane Library. The primary outcomes evaluated in this review were overall survival, disease-free survival and local recurrence. Secondary outcome was the incidence of surgical site infection. All data were analyzed using Review Manager 5.3.Results
Thirty-one studies, involving of 139,894 participants were included in this paper. Pooled data demonstrated that women who had IBR after mastectomy were more likely to experience surgical site infection than those treated with mastectomy alone (risk ratios 1.51, 95% CI: 1.22–1.87; p = 0.0001). There were no significant differences in overall survival (hazard ratios 0.92, 95% CI: 0.80–1.06; p = 0.25) and disease-free survival (hazard ratios 0.96, 95% CI: 0.84–1.10; p = 0.54) between IBR after mastectomy and mastectomy alone. No significant difference was found in local recurrence between two groups (risk ratios 0.92, 95% CI: 0.75–1.13; p = 0.41).Conclusions
Our study demonstrates that IBR after mastectomy does not affect the overall survival and disease-free survival of breast cancer. Besides, no evidence shows that IBR after mastectomy increases the frequency of local recurrence. 相似文献16.
17.
Michael Frelinghuysen Jesse Fest Noelle C. Van der Voort Van Zyp Bronno Van der Holt Mischa Hoogeman Joost Nuyttens 《Clinical lung cancer》2017,18(6):e403-e409
Background
Inoperable patients with early stage lung cancer are referred late. The purpose was to calculate the referral time and the volume doubling time (VDT), and to investigate its consequence with regard to staging and survival in 117 inoperable patients with early stage lung cancer treated with stereotactic body radiotherapy.Materials and Methods
Tumor VDT was calculated using the modified Schwartz formula of exponential growth model and was on the basis of volumes measured on initial diagnostic computed tomography (CT) scans and the planning CT scan. VDT was defined as fast (<100 days), moderate (100-249 days), slow (250-399 days), and no growth (≥400 days). The referral time is the time between the diagnostic CT scan and the radiotherapy planning CT scan.Results
The median referral time was 86 days. The VDT was fast in 53 patients [45%] of tumors. No significant difference in VDT was found between different tumor or patient characteristics. Patients with T1 tumors that progressed to T2 had a significant worse median survival (P = .01). The overall survival at 5 years according to VDT was 21% for fast-growing tumors, 19% for moderate growth, 31% for slow, and 46% for no growth.Conclusion
The median referral time was almost 3 months. VDT was considered as fast in almost half of tumors examined. This resulted in significant growth and upstaging in 35% of the tumors, with a significant worse survival if T1 tumors progressed to T2 tumors. Therefore, medically inoperable patients should also be offered a fast workup and referral. 相似文献18.
Hitomi Sumiyoshi Okuma Hidehito Horinouchi Shinsuke Kitahara Tetsuhiko Asao Kuniko Sunami Yasushi Goto Shintaro Kanda Yutaka Fujiwara Hiroshi Nokihara Noboru Yamamoto Yuichiro Ohe 《Clinical lung cancer》2017,18(2):234-240.e2
Background
Although several agents have been introduced for the treatment of relapsed small-cell lung cancer (SCLC), there is still only limited evidence regarding second- and later-line chemotherapies for these patients.Patients and Methods
Consecutive patients with relapsed SCLC treated at the National Cancer Center Hospital between 2000 and 2014 were analyzed. Patients' characteristics and treatments to explore factors associated with the survival outcomes were reviewed.Results
A total of 580 patients diagnosed as having SCLC received first-line chemotherapy/chemoradiotherapy, of which 343 (59%) received second-line chemotherapy. Among the 343 patients, 193, 148, and 2 patients were diagnosed sensitive relapse, refractory relapse, and relapse of unknown sensitivity status, respectively. Second-line chemotherapy regimens used were as follows: amrubicin (AMR) in 188 (55%) patients; weekly cisplatin/etoposide/irinotecan (PEI) in 56 (16%) patients; topotecan in 18 (5.2%) patients; others in 81 (24%) patients. In the analysis including all patients, the following outcomes were obtained for the patients treated with AMR and PEI, respectively: objective response rate: 51% and 73%; median progression-free survival: 4.5 and 4.2 months; median overall survival: 10.0 and 10.8 months. Multivariate analysis identified sensitive relapse to first-line treatment (vs. refractory relapse) (P = .007) and AMR as second-line treatment (vs. PEI) (P = .005) as independent favorable prognostic factors for survival.Conclusion
AMR showed a favorable trend compared with PEI in terms of the progression-free survival and feasibility in SCLC patients with relapsed disease. Based on our findings, we suggest that a randomized trial comparing AMR and PEI is warranted. 相似文献19.
Ashley Bond Paul O&#x;Toole Gareth Fisher Sreedhar Subramanian Neil Haslam Chris Probert Trevor Cox Sanchoy Sarkar 《Clinical colorectal cancer》2017,16(1):44-50
Background and Aim
Adenoma detection rate (ADR) is the most important quality indicator for screening colonoscopy, due to its association with colorectal cancer outcomes. As a result, a number of techniques and technologies have been proposed that have the potential to improve ADR. The aim of this study was to assess the potential impact of new-generation high-definition (HD) colonoscopy on ADR within the Bowel Cancer Screening Programme (BCSP).Method
This was a retrospective single-center observational study in patients undergoing an index screening colonoscopy. The examination was performed with either standard-definition colonoscopes (Olympus Q240/Q260 series) or HD colonoscopes (Olympus HQ290 EVIS LUCERA ELITE system) with the primary outcome measures of ADR and mean adenoma per procedure (MAP) between the 2 groups.Results
A total of 395 patients (60.5% male, mean age 66.8 years) underwent screening colonoscopy with 45% performed with HD colonoscopes. The cecal intubation rate was 97.5% on an intention-to-treat basis and ADR was 68.6%. ADR with standard-definition was 63.13%, compared with 75.71% with HD (P = .007). The MAP in the HD group was 2.1 (± 2.0), whereas in the standard-definition group it was 1.6 (± 1.8) (P = .01). There was no significant difference in withdrawal time between the 2 groups. In the multivariate regression model, only HD scopes (P = .03) and male sex (P = .04) independently influenced ADR.Conclusion
Olympus H290 LUCERA ELITE HD colonoscopes improved adenoma detection within the moderate-risk population. A 12% improvement in ADR might be expected to increase significantly the protection afforded by colonoscopy against subsequent colorectal cancer mortality. 相似文献20.
Yu Jin Lim Ji Hyun Chang Hak-Jae Kim Bhumsuk Keam Tae Min Kim Dong-Wan Kim Jin Chul Paeng Keon Wook Kang June-Key Chung Yoon Kyung Jeon Doo Hyun Chung Hong-Gyun Wu 《Clinical lung cancer》2017,18(3):e169-e178